Heartburn is an uncomfortable burning sensation behind the breastbone that extends upward from the epigastrium. In healthy people, it appears with food errors and alcohol abuse. Most often observed with reflux esophagitis, gastric ulcer, 12 duodenal ulcer. Less commonly, it occurs with other diseases of the gastrointestinal tract, infectious and neurological pathologies. To identify the causes of heartburn, endoscopy, intragastric and intraesophageal pH-metry, tests to determine gastric secretion, abdominal ultrasound, and microbiological studies are performed. In order to prevent and reduce retrosternal burning, it is recommended to correct the diet, quit smoking, alcohol, and take antacids.
Heartburn is felt as a burning or heat sensation along the esophagus, often associated with sour belching, choking, and coughing. Discomfort occurs in the epigastric region, extends upward beyond the sternum, may radiate to the neck and be felt in the throat. Often the symptom appears half an hour after eating. In a healthy person, heartburn is usually preceded by overeating, the use of spicy, smoked and fried foods, alcoholic beverages, strong tea, and coffee. In gastrointestinal pathology, retrosternal burning is associated with the intake of both irritating and ordinary food.
Strengthening heartburn contributes to rest in a horizontal position, tilting the body forward, physical activity immediately after eating. After a burning sensation in the esophagus, a sore throat often occurs. With an increase in episodes of retrosternal burning up to several times a week, they are accompanied by cough and other signs of dyspepsia (frequent sour, putrid belching, nausea), it is recommended to consult a gastroenterologist. The combination of heartburn with vomiting of blood, dark stools, intense pain in the chest and back is an indication for seeking emergency medical help.
Usually heartburn is associated with damaging effects on the esophageal mucosa. Most often, the symptom is provoked by reflux of gastric juice and digested chyme. At the same time, both hydrochloric acid and proteolytic enzymes have an irritating effect, and the appearance of heartburn often indicates the presence of esophagitis. In the course of esophagomanometric studies, it was found that in most patients experiencing retrosternal burning after eating, the cardiac sphincter is weakened, the pH level in the distal part of the esophagus does not exceed 4.0.
The reflux mechanism of symptom development is characteristic of both gastroenterological diseases and heartburn during pregnancy. During gestation, the weakening of the cardia is facilitated by an increase in intra-abdominal pressure due to an increase in the growing uterus. An additional pathogenetic link in pregnant women and patients suffering from stomach ulcers, duodenal ulcers, hyperacid gastritis, helicobacteriosis, is the high aggressiveness of gastric juice due to an increase in its acidity and increased cardia failure against the background of gastric hypermotility.
The mechanism of heartburn development in atrophic gastritis, pyloric stenosis and gastric cancer is based on insufficient digestion of food, the predominance of fermentation processes, the formation of a large amount of lactic, butyric and other organic acids. Stagnation of chyme caused by impaired evacuation is accompanied by stretching of the gastric wall and cardiac sphincter with reflux of contents into the esophagus. After total gastrectomy, burning is provoked by the action of bile and pancreatic enzymes on the esophageal mucosa, which enter through the formed anastomosis.
Less often, retrosternal burning is caused by stretching of the esophageal mucosa with achalasia of the cardia, volumetric neoplasms, strictures. The same is the pathogenesis of heartburn in hypermotor dyskinesia of the esophagus, however, a decrease in the threshold of sensitivity against the background of autonomic disorders often becomes an aggravating factor. A special pathophysiological mechanism underlies the formation of a symptom in patients with temporal lobe epilepsy. With somatosensory paroxysms, a burning sensation behind the sternum is caused by the presence of a focus of pathological impulses in the brain.
Taking into account the predominant localization of uncomfortable sensations, a more common heartburn in the chest and a less common form with a burning sensation in the throat are distinguished. To determine the severity of a symptom, the frequency and circumstances of its development, intensity, connection with food intake, and other features of the experienced discomfort are usually used. This approach is effective for conducting a diagnostic search, selecting the best ways to correct heartburn, taking into account the causes of its occurrence. Based on the proposed criteria, three degrees of severity of the disorder are distinguished: